结核性与恶性胸腔积液的鉴别诊断

目的 提高结核性胸腔积液(TPE)与恶性胸腔积液(MPE)的诊断水平。方法：对460例TPE和66例MPE病人的临床资料进行回顾性分析。结果 结核菌素(PPD)试验：TPE中度阳性占54．6％，强阳性占19．1％，MPE阴性占42．9％，一般阳性占38．8％；TPE痰结核茵检查阳性占36．7％，MPE痰找瘤细胞阳性占4．5％。胸水实验室检查TPE：胸水呈黄色占90．6％，胸液抗酸杆菌阳性率15．2％，MPE血性胸水占75．8％，胸液癌胚抗原(CEA)阳性占60．6％，胸液癌细胞阳性占62．1％。结论 PPD试验，胸液性状、CEA、瘤细胞检查对TPE与MPE的鉴别价值较大。

Differential diagnosis in patients with tuberculous pleural effusion and malignant pleural effusion

Objective To raise the diagnosis level of tuberculous pleural effusion (TPE) and malignant pleural effusion(MPE). Methods Clinical data of 460 cases with TPE and 66 cases with MPE were retrospectively analyzed. Results The moderate and strong positive rate in purified protein derivative(PPD) reaction for TPE was 54.6%, 19.1%, and the negative and common positive rate for MPE was 42.9%, 38.8%. The positive rate of M. tuberculosis in sputum for TPE was 36.7%, and the positive rate of cancer cells in sputum for MPE was 4.5%. The patients with yellow pleural effusion for TPE was 90.6%, the positive rate of M. tuberculosis in pleural effusion was 15.2%, and the patients with bleeding pleural effusion for MPE was 75.8%, the positive rate fo carcinoembryonic antigen(CEA) in pleural effusion was 60.6%, the positive rate of cancer cells in pleural effusion was 62.1%. Conclusion PPD test, quality of pleural effusion, positive rate of CEA and cancer cells in pleural effusion had a large value of differential diagnosis for TPE and MPE.